Fran Hegarty : Innovation in Healthcare Technology and its Management - can we plan for new ways of working?I’ll introduce myself in a minute because the first few slides kind of do that. So thanks for inviting me to come. When John asks you to come to this it’s a couple of months ahead so I’ve become quite skilled at coming up with titles for talks that means absolutely nothing so that you can change them on the day. And so that’s what I’m going to do. So hopefully the slides, we can make them work. Now I think the best introduction for the talk I actually got from a comment I got from Ted last night. So I was talking about my 16-year-old son who has to make the decisions about what courses or what subjects he’s going to do through school and university now. And Ted said that actually kids these days have to think about having three careers, because the pace of change is so fast that really you have to think about, and, you know, what is that, it’s such a weird thing to be doing, to be trying to decide whether you’re going to do maths or history now.

And so that really stuck with me, and I actually think that’s a really good introduction for this talk. Because what I’m trying to do with my colleagues in Ireland at the moment is a bit of a social experiment. We’re trying to imagine what is clinical engineering really going to be in the next 10 years, and you’ll see why in a minute. The same son I recently had a conversation with about actually whether we were geeks or dorks. So this is my only joke, right, just picking up I’m not going to try and do jokes after Ted. Whether we were geeks or dorks and we were having this conversation and then my 13-year-old daughter turned round and said it’s very clear you’re both at the same time. So I think that kind of did it for me.

Now, OK, so a lot of people have started with these pictures today. I felt the need to do it to somehow establish my credibility that I started off as a med tech fixing stuff in the early days, but actually there’s a really interesting point about looking back before we look forward. And when I reflected on it after Ted’s comment last night I think I’ve had four careers so far in the clinical engineering space. So this is probably happening if you’re hanging around in technology you have to reinvent yourself regularly anyway. And so this is what stuff looked like in the early ‘80s when I started and lots of people would be nostalgic about it. But one of the real positives about this stuff was that it was fairly discreet components inside. So it was unreliable too, it broke down quite a bit, and our main job was keeping it going. And so we actually got inside machines and we, a lot of different machines, if you’re a clinical engineer there was a kind of a badge of honour as to whether you could fix these things without the service manual. Does everyone remember those days? And if something went wrong you could get the parts usually from Farnell or Radio Spares or people like that that that you weren’t actually having to go back to the companies.

So there was a kind of a community of people who built up looking at technology from lots of different manufacturers, lots of different ways about how stuff goes together. So it was really good engineering thinking and starting to understand how systems and stuff comes together and that went into our profession. And just to go back to the ego, that’s something that’s in our profession that we own and we don’t apologise for and we actually value that, that we’re good at engineering and systems thinking. And then things moved on and we got a lot of this sort of stuff coming in. So they all had screens and they all involved software. So it was about the move to the whole microprocessor piece. So I started in 1982, first microprocessor ventilator came out from Draeger in ’82, a 4k processor.

So then we had to embrace all this and I know the people and I see the nods in the audience and everyone went oh we can’t fix boards anymore, we can’t get the components, what’s clin eng going to do? And we had to change what we do and we evolved to do a different job. And we got much more into supporting the complexity of this technology and looking at where it sits in the delivery of care. And what our real job became was about managing the interface between these new emerging advanced technologies and the practice of medicine. Because doctors don’t study engineering or physics, they study chemistry and biology and life science stuff, and we’re the physical sciences people. And then things moved on again, about another 10 years on or so, and we got to this sort of stuff, where it’s very highly integrated, very soft, very driven and very much systems now.

So if you just go from the anaesthetic machine down here which didn’t even have a plug to sort of 20 years later what we were doing with all the feedback and the systems, it’s really interesting the development. So what happened over the period? How would you describe it? There was a big increase in reliability, so we stopped doing fixing, OK. But we didn’t go out of business, because there was also a big increase in complexity. So we started to manage that complexity and how it’s delivered in care. And then there was a huge increase in the number. So there was a four-bedded ICU in St James’s, Dublin, when I started, and we had three ventilators. We now have a 60-bed ICU and we’ve 70 ventilators, so a huge increase. And stuff that was in the ICU back in the day was out in the HDU, what was in HDU is now out in the wards and a lot of the stuff that’s out in the wards is now out in the community. So a big explosion in the number, and that brought us into the whole thing of a big investment and therefore there was a need for financial stewardship around that and the asset management piece and all of that, so massive growth.

So I real feel having sort of rode that journey over the last 36 years or so that I’ve had to change and reinvent myself all along. And I think that’s what’s going on. And then this was the next one, the convergence with the ICT. So I’m going to try something now with this slide. So it’s really, this is a picture of St James’s ICU from about two months ago. And you can actually look at that slide with a 1980s, ‘90s, 2000 or today view. So you could for example, there are some people that I suspect are looking at that and go, really interested in that infusion pump there, and its power supply and its electrical safety and whether it’s EE marked and all that, and then there’s people who are looking at all that equipment there and the patient and what’s really going on with that.

And then there’s people who are looking and saying there’s all that equipment there and there’s that computer system and all the data’s going across. And then there’s people who are looking and saying look at that nurse trying to care for that patient through all that technology pathway. So just see which one you identify with the most. But I guarantee you that people who are closer to my son’s age look at that picture and see absolutely no difference between this and this. So if in your mind said you’re seeing that as a different thing to that, I would ask you to reflect and question that that’s probably just some sort of construct you’ve had in your mind that you’ve created in that there isn’t much difference between the two at all. So this thing about, you know, do clinical engineers need to learn computers and all that, actually is the answer not so obvious? Of course we do right, OK.

So what I’m really thinking about is, what’s coming and where do we need to go. And I’ve a particular reason because as some of you know in Dublin at the moment we’re building a new children’s hospital and we’re thinking of that. So summary we’re doing less inhouse repair and maintenance. We’re outsourcing more maintenance. But actually we’re not just doing that casually, we’re very carefully looking at that. And we’ve got very good at managing the economics of that and where is the value and finding those solutions and working with companies and managing service contracts and all that. I feel I should point over for some people. I’ll come over here in a minute, I’m not ignoring you, it’s just a kind of a weird bias thing. OK. So that proactive asset management piece has come into it and we’re much more involved in user support.

So the last time I did a measure before I left James’s to go on this new project in theatre, 60% of things that were reported as technical faults in the theatre were actually user error issues. So with DEFRA we’re very involved in training and getting involved in that, and I think very particular we were doing a lot of informatics support by the end. So once we brought our ICU completely paperless and we had the datasets, the doctors were coming to us and saying things like we’ve got a patient in with a particular infection, can you look at the last 100 patients who had that infection, what antibiotics did we give them and plot their white count against antibiotic delivery. So they’re the sort of things they were coming and asking us. They weren’t asking us can you come and look at the pressure waveforms from the ventilator anymore because they kind of had that piece, where that had been automated out.

So we kind of are riding that journey of user support going out really far into the clinical space. And we know that there’s new technologies coming and there’s new ways of providing care, so we know we’re going to have to come up with new ways to support both of those, and we’re trying to imagine what the hell that is. And this is the beast we’re building. So that’s the existing St James’s hospital where I grew up, which is a 1,200 bed adult all the acute specialties for Ireland. That’s the medical school, Trinity Medical School on the site, and this thing down here is a new paediatric children’s hospital which is being built at the moment so we’re out of the ground, out of the concrete and it’s coming up and it’s a big project. And we’re hot in the news in Ireland at the moment, we’re the second thing after Brexit, because this has gone over budget and CEOs and chairmans of boards have been fired and all sorts of stuff, but anyway equipping has managed to survived, so we’re on track.

So our team has been pulled together to equip this. And again just an interesting note. So the equipping team, the procurement team that are supporting the equipping team have been taken out of central procurement and they’re put in with us, but they report through me up to the executive. So our CEO has said it’s so strategically important to get the medical equipment right and the future funding of that that we’ve put it in the hands of the clinical engineering medical physics people and then procurement work in the team with us. Now we’re very non-hierarchical so they tend to be there and do their piece, and it’s definitely procurement more than purchasing, but we’ve gone that far with it.

So we’re trying to think what’s the future? So here we are 2019 and we’re opening in 2022 and we’re trying to think out what’s the equipment? So that’s also a big challenge and made us sort of think of challenges to think about for the future. So we can take a guess of what imaging systems and lab stuff we’re going to put in and we’re going to start making decisions in 2020 and that’ll roll in and we’ll know that it’ll all fade away and sometime around 2030 we’ll have to replace it. So that’s kind of known. And we’ve gone back to the government and we’ve said we’re going to come looking for the money again here and try to get that on the plan for government. And we know that our colleagues in the medical ICT they’re trying to roll out any HOR and they’re on a similar thing. We expect that they’re sort of refresh cycles are in servers and software will be faster than ours. And that of course is a very 2000 view of the world.

So what we’re really trying to do is push ourselves: OK well let’s do a more developed view of the world. So a more developed view of the world is to put this picture in which I’ve taken from Best Upon Request’s website, I’ve borrowed it. So this is the picture that’s really important to us and there’s no tech in the picture very deliberately. So what we’re really trying to deliver is good care for kids and for their families and good access, and it’s been done in a way that really respects them as individuals and their dignity in that. So it pulls your head a long way away from the geeks and the dorks, which I’m happy to label myself as over here, to go into this space. So therefore we’re working a lot with our clinical colleagues and they’re thinking out what’s the future model of care for kids in Ireland? And they’re rethinking how all the specialties work and how referrals work to try and get that transformation.

So we have a whole team of people looking across 39 specialties rethinking out what paediatrics is going to be in Ireland. So we’re in with them trying to understand what they’re doing and then trying to get the tech and the environment right. And we know from talking to them that they’re going to iterate over time as well. So they’re building a lot of their systems with very fast turnaround and quality systems built into it. And so if you look at all those hard lines and just project them up you can see that actually buying equipment for a particular date is fairly meaningless looking into the future because it’s all going to change. So early on we said there’s no point in buying the equipment at all and we embraced the concept of the managed equipment service and we tried to get that over the line.

And we did a lot of work on the finance actually and a huge amount of planning and we were able to bring in economists because the big project we were able to bring in EY and Deloitte and work with that. And I was very sceptical at the start, because I’d come from a traditional background, but actually on an economics argument I think it holds out in the long run. And we could have a great conference about that actually just to explore that out. And I think the reason it works out is for two reasons: you aren’t paying the profit up front and secondly the future value of money, and when you’re correct for those two it economically becomes even. And in Ireland we don’t have the VAT advantage, so you can’t claim the VAT advantage in Ireland, and it still plays out, but it’s a complicated financial piece.

The problem with it is that everything that’s nice about this picture here you can’t put on a spreadsheet. So you cannot actually go in to a finance guy and argue for a better patient experience, they only want to see stuff that goes on. So ultimately our argument to get an MES over the line has failed in Ireland. We won it in our equivalent of the NHS. We then won it through our Department of Health. But we didn’t win in our Treasury, our equivalent of the Treasury, because they were saying a lot of assumptions plus you can’t put a money value on that quality experience, which is a bit disappointing. But we haven’t given up yet, because in Ireland we just keep fighting at it, so hopefully we’ll get something over the line. But it does mean now that we’ve had that argument with the Treasury and back to your point, we’ve sort of said well OK you’re saying no to us now at an MES but you do know we’re coming in 2030 looking for all this money again. So we started the argument with them saying well where are you planning for the future to refresh this hospital?

So by even going there with an MES argument and having it and having the conversation we’ve created the dialogue where we’re up front several years out from having to come looking for the refresh, we’re saying you guys better be planning to refresh this equipment over this period. And it’s changing the narrative with our Treasury Department and how that’s working. That’s the problem with these talks, when you come for a conference I try to focus on everything that other people have said and then you lose the hang, but that’s what’s really important to us.

So now here’s an interesting take. So we went looking at, you know, what should we really be doing? And we were very clear we needed to move beyond tech, we needed to move into trying to support the patient experience, try to really support transformational change and that. And we started talking to our CEO. So the main thing that we did differently was we talked to people. So we didn’t stay in the basement, we got up and we got out and we went to meetings and we talked to people and we started to talk. And I think we had that lack of ego as well, but we amplified the ego. And we amplified the ego and we gave ourselves permission to amplify the ego by saying we’re trying to represent patients and their families. So that gave us the confidence to really amplify the ego. And we started to talk to it. And we found this document, I don’t know, do you guys know this?

So we borrow stuff from the NHS all the time. The reason this document is important to us is that this is the document where our CEO came back to us and said I see what you’re saying Fran, I get it now, I’ve read this and this makes sense. OK. So this when the CEO’s response to clin eng saying we want to get involved in transformational change. So I won’t go into, you can get this, obviously it’s online, they’re sort of saying that the strategic NHS reform, it needs a framework with five layers, and the five layers are manage the costs, do the process improvement, look at new ways of care, population health and adopt the scientific thing. So our CEO was at a presentation she said OK this is for Fran I’ll have to talk to Fran about this, but then she had the revelation and she brought it back. And this is really interesting. So the document also says that you can drive the change by doing stuff at government level, you can do it at system level or you can actually empower people on the ground to do it. OK. So there’s a real merit in just getting the existing people in the hospital and giving them permission to change what they’re doing, get out there and do something new and drive change. So we used this from this document and then we used the metrics.

So this document is very qualitative, it sort of says what are the opportunities for improving the Health Service? And it did sort of a time series and it looked at the contribution of different ones. So it’s very interesting. So this probably isn’t hard science, but it’s worth looking at because of the way the CEO looked at it. So let me give you this and then you can turn this back on your CEO and see how it works. So this document says that there’s a great return on doing cost management and there’s early return. OK. So this came out in 2015 and it was saying all that stuff about supply chain and actually looking at procurement and managing your costs, all that, that’s good, that gives you a return. OK. And it also said, actually the scientific discovery and new technology and bringing that in, that’s going to bring a return, that’s good, and it has felt fairly constant actually over the last 30 years.

It’s been constant those new things were coming in, now that did scale and there was more equipment, but it did sort of feel that every two or three years something really new comes along and you adopt it. But look at the opportunities here when you look at doing process improvement and quality. And take it back to my first point that when we were fixing kit in the old days we were really good at going into areas and solving problems where we didn’t have the service manual, because we can go in and we can think it out from first principles and from scratch using system theory, OK.

So we probably have a role to play in here. Certainly when new ways of care are being delivered, where there’s tech involved we’re in that space. So we’re down here, we’re down here and we can probably work into the middle. The last one is then the focus on population health, which is stop drinking and become a vegan and everything will be better, and that’s definitely true. But that doesn’t have much of an impact in the tech space and I’ve no intention of stopping drinking or becoming a vegan, so I’m going to ignore that one. But if you just scale that and accept it is a qualitative thing. Look at the potential for improving things for kids and their families up here. OK. So then we kind of went OK, so here’s our history, we’ve moved away from tech, into asset management, into user support, doing the informatics, new technologies are coming in, so we’re trying to fill in here and we’re looking at this diagram and we’re saying OK there’s something here that we possibly could be doing and can be doing. We can solve this, there’s a whole, the whole Health Service has to focus on this and make it better because we have to transform health because it’s just not sustainable as it is at the moment, so we have to attack that.

So what’s our role in that space? And that’s what gave us this. So is there an imperative on us to go further than this? And I think there is. And so we’ve always been saying what we do is the combination of the equipment management and the support and the care, and then is there an opportunity to do something really disruptive here? And this is the social experiment that we’re trying at the moment. So the term disruptive innovation, I’ll just go through that, it’s not good to be disruptive, OK, because that’s breaking something. But disruptive innovation is OK. Because if you’re doing innovation you’re doing something new so it’s better. So if you’re disrupting a system by making it better, so it’s OK to use the term disruptive if it’s with innovation, but just being disruptive I don’t think is helpful. And to me innovation, there’s loads of definitions, it’s a very widely used word now, it’s only innovation if there’s a creative step in it as far as I’m concerned. So quality improvement is fine. But if there isn’t a creative, imaginative step to do something new, I’m not sure it’s innovation.

So here’s where we’re going with it. This is the language. So here we go, I borrowed this from Baxter. I hope nobody minds. I think it’s a really nice slide of the sort of stuff that goes on because it allows me to explain. So we’re all here guys, we’re all doing the asset management. We will be doing the asset management, that’s not going away, so don’t worry we’re going to be doing that and we’re going to be doing it within some structured framework and taking an holistic view hopefully of that, including training the staff and the long-term strategic management and all that. But there’s probably more we can do. And the two things I think which are helpful is just this concept of a sociotechnical system and just to think about what that is.

So when I look at this slide now, I’m seeing environment, patient, patient very intimately connected to these devices, staff, doctors, different people having to work in different ways around this. So this is a kind of a mixture of people and culture and attitude and mindset as much as it is different technologies that delivers the thing, and just to acknowledge that, that’s the first thing. And then the second thing is just to say that if you take a systems approach, so there is a theory around how you put systems together, and we’re all really good with it because we’re all geeks, even if you’re not a dork you’re a geek, which means that you’ve probably gone through and you inherently have a sense of logic and systems and interrelatedness and how you can use feedback and stuff to improve things.

So we are innate systems designers and we’re in hospitals. And we’re one of the few engineering groups that hanging around a hospital, OK, at the point of care, really seeing how it’s delivered. So we can bring a skillset to help change that. Now I’m not saying we are responsible for it, I’m not saying that, but we can provide a little bit of leadership and we can turn up the ego a bit, get outside of the basement and go up and get involved in more quality improvement teams and bring that engineering skillset to bear on more than the technology, certainly the technology in its application and possibly further into just looking at process flow and helping there.

So I want some new feedback and I’ll be asking at the end. So just a few things, does this sound right? So the definition of a sociotechnical system is that it’s a system, it refers to the interrelatedness of the social and technical aspects of the organisation, does that sound right for hospitals? Yes, OK. And the theory says that the interaction of the social and technical factors create the conditions for a success, does that sound right? And it goes further to say, if you only manage the tech or you only manage the people in isolation, you create an environment where unpredictable things happen that probably means you don’t get success. Does that feel right? That feel right? Yes, OK, some nodding. OK. So another way of looking at it, if you want to bring that back, yes. And then the systems engineering approach if you look at the definition, first of all it’s an activity that’s interdisciplinary by definition. And you bring interdisciplinary people together to build successful systems, does that sound like hospitals? Yes. So you definitely bring them in, special groups, into team efforts to try and do a structured process to improve things.

So I think those two definitions gives us the permission and probably the amplifiers to turn up our ego a bit and to drive in and do a bit more than we’re doing at the moment. So using sociotechnical system design, using a systems engineering approach, can we improve things? And I’ll give you just quick examples of sort, so we know things like our new acute hospital is a really complex system and in there there’s loads of functions that interrelate, so I’ll show you the sort of thing it could be, you could have your A&E, your operating theatres, your intensive care, your general wards. And you want your hospital to be green and working really well, so therefore you want all your functions and the relationships to be right. But see if this makes sense, I did this in James’s and literally I improved something in the theatre.

So I thought it was a great day, shiny badge for Fran, because I made the operating theatres really golden and they did a great thing. And we started to get patients through the operating theatres quicker. But by doing that it really challenged the wards and the intensive care, because they were coming out and their beds weren’t ready and, yes, so there was all sorts of stuff going on. And then they all tried to cope by early discharging patients. So they started to early discharge patients from ICU back to the wards. We couldn’t get A&E into the intensive care so they started to say can we bring them to theatre earlier? And the whole thing kind of destabilised and eventually the wards went pop. So this is the equivalent, I drive a Panda, a ’94 Panda. This is the equivalent of putting a big souped-up engine in that car. The first time I drive it down the road I’ll crash into a wall right, because the system as a whole won’t work, even though I max out the engine.

So really what we had to do is go back and undo that change and make everything go back to green, and then redesign it and implement it but this time taking into account the fact that we had to actually look at the other parts of the system as well and we couldn’t think about things in isolation. So does that make sense? And you can see how clinical engineers, medical physics colleagues could do that sort of stuff. And while you mightn’t be maybe leading on that change, your presence in the room and your ability to think like that would add a lot of value. The other one we’re doing at the moment, because we’re doing a big EHR, you can look at this as saying the staff, the care pathway, the medical equipment, the ICT guys, so one of the things that’s happening at the moment that we’re a little fearful about is we’re putting tons of effort designing the EHR, the medical equipment and the staff, but are we really thinking about how it’s going to go out to the GP network and are we looking out into the community enough about that. Because if we don’t then the patient experience when they leave the hospital might go off. So you can see how this sort of thinking can be helpful in that and I think we’ve a lot to gain in that.

Now I’m getting a bit tight on time so I’m going to skip through this. Just to say that there is a methodology. It’s written up, you just, you start, you get your team together, you think about what you’re doing. The important thing is that you synthesise a change, you come up with something new and then an important thing is you look at it in the context of the system as a whole and you go around. And when you look at this diagram on paper, there’s stuff that’s really innate to us. Like nobody in this room is going to be freaked out by saying there’s a load of feedback built into that system. But actually when you’re in a room with a bunch of hospital managers or finance people and you start talking about what feedback really means, actually not sure that they get it to the same level, so there is a real merit in getting involved in that.

So here’s the social experiment we’re going with and I’d be interested to see what you think. We know all this is coming, 3D imaging, way past augmented reality now into spatial computing is really starting to hit us, augmented intelligence, don’t believe in artificial intelligence at all, it’ll never replace the humans, not worried about that bit, but how augmented intelligence would be plugged in and change how we work and the roles I am very interested in, so there’s lots coming. But we do know that all medical technology will need active holistic management. So that’s not going to go away, so that’s OK. New technologies will emerge. We can’t imagine what they are going to be at the moment. Somebody in Ascentia said to me recently in 10 years’ time people are going to be around going what were we all doing going around having a mobile phone in our pocket, what was that about? So it’s only 10 years since the iPhone came so they reckon that that’s going to really go away.

Whatever those technologies are and if they’re going to plug into the system they have to plug in as part of a sociotechnical system. So they won’t go in just as technology on their own. And guess what, we’ve been doing that for the last 30 years anyway. Every time something new came, we were the people who managed that interface into the sociotechnical system. So let’s just use that term and say we’re good at it and experts at it and give ourselves permission to have a go. And then the future healthcare systems really could benefit from taking that systems approach because that’s what allows you to find the efficiencies in all that, so I think that’s a disruptive piece that we can do.

So the social experiment we’re doing at the moment is we’re designing a new department, and it’s kind of clinical engineering, medical physics, and we don’t put a hard divide between those two either, I’ll tell you I think they’re both social constructs as well. But we’re going to have a block of people who are going to do the proactive asset management and they’re going to be specialists in there. There’s going to be people who do imaging and do endoscopy and do dialysis and do ICU and go out to the community, so there’s going to be some sort of specialisation and they’re going to be doing that. But there’s a lot more to be done than that. So we’re also going to have people who are going to be working in the clinical informatics space. We’re not going to try and take our existing clinical engineers and make them IT guys; we’re just going to invite more people into the club. Because actually the whole thing is that it’s all about hyper-specialisation going on.

So there are IT people out there who would be really good in the space. Not all the IT in the hospital, like the guys who are running our staff system and our HR and all that, they’re really good or the guys running the desktops, they seem to know what they’re at, they keep everything going, I don’t have a problem with them. But we need to find a kind of a new breed of person to bring into the club who’s doing the clinical informatics piece. And some of our people in here are retraining. We’ve three people who have done masters in health informatics and are sort of learning that space, but also we’re seeing people in this world trying to come in and learning more about life science stuff and getting to that.

Another one we really see is what we’re calling clinical AV. So we’re seeing people from the local art college getting very involved and coming up, our local art college has set up a master’s in medical device design and they come up to the hospital and they do rapid prototyping with us. So we’re starting to see this convergence of people who come from the art college and have a great way of looking at the world which is about materiality and about somatosensory stuff and that sort of thinking coming in and adding a huge, and I think that’ll be really important as we get these really digitally, or reusing all that imaging and we’re fusing imaging and we’re looking at new ways of doing it, I think we’ll need people who are specialists in perception and stuff like that as well. It’ll all kind of find expression through clinical application support and a lot of the what we call the asset management will actually leech well into the application support space, and I think the language more and more will be about healthcare technology, quality and safety, and that’ll be the lens that will be there and then it’ll drop down into these other things.

It’s for another day, but I do think our continued involvement in R&D and driving the tech innovation is important. And this is the one that’s really interesting: do we really set up a division in here that’s actually about really fostering the systems approach and taking the sociotechnical system design. So one of my colleagues has been asked to go out into the ED, looked at why their flow through ED was blocked and sort of did a logic diagram for it and realised they needed to rapid access clinics on particular days, set that up and then they smoothed it at the flow. So there was no tech involved but it was definitely a sort of a systems engineering thinking. So we’re being asked into those quality improvement programmes more and more. So the social experiment we’re doing and I’m really interested in your view is just to abandon the concept of a clinical engineering department, a medical physics department, clinical informatics, and we just call this thing the healthcare technology office for want of a better term at the moment. And it’s not that it’s a department, it’s more like a way of working. It’s a club, it’s a culture.

So it’s kind of housed in medical physics and clinical engineering at the moment, but it invites anybody who’s interested in trying to advance care through the application of technology or systems thinking to come in and work in a collaborative way. And so therefore we intended to be completely porous with the industry and academia, but we’re starting to see doctors and nurses show up here. We’ve seen one psychologist who’s come in who’s part of the quality improvement programme who has a big background in human factors get involved with us. We’re seeing creatives from the art college showing up, some managers and educators coming in. So it feels like if we can take a more holistic approach. Perhaps we’re evolving out of the clinical engineering, medical physics type thing into something more holistic like this.

So that’s the experiment we’re running. And one of the advantages for me to come in here is that I get to say it in front of people because we’re halfway down this path, so I’m very interested in feedback.


 Fran Hegarty's presentation at the EBME Expo : Innovation in Healthcare Technology and its Management - can we plan for new ways of working?


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